SUNCT/SUNA and neurovascular compression: New cases and critical literature review

Valentina Favoni, Daniela Grimaldi, Giulia Pierangeli, Pietro Cortelli, Sabina Cevoli

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Background: Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with cranial autonomic symptoms (SUNA) are primary headache syndromes. A growing body of literature has focused on brain magnetic resonance imaging (MRI) evidence of neurovascular compression in these syndromes. Objective: The objective of this article is to assess whether SUNCT is a subset of SUNA or whether the two are separate syndromes and clarify the role of neurovascular compression. Method: We describe three new SUNCT cases with MRI findings of neurovascular compression and critically review published SUNCT/SUNA cases. Results: We identified 222 published SUNCT/SUNA cases. Our three patients with neurovascular compression added to the 34 cases previously described (16.9%). SUNCT and SUNA share the same clinical features and therapeutic options. At present, there is no available abortive treatment for attacks. Lamotrigine was effective in 64% of patients; topiramate and gabapentin in about one-third of cases. Of the 34 cases with neurovascular compression, seven responded to drug therapies, 16 patients underwent microvascular decompression of the trigeminal nerve (MVD) with effectiveness in 75%. Conclusions: We suggest that SUNCT and SUNA should be considered clinical phenotypes of the same syndrome. Brain MRI should always be performed with a dedicated view to exclude neurovascular compression. The high percentage of remission after MVD supports the pathogenetic role of neurovascular compression.

Original languageEnglish
Pages (from-to)1337-1348
Number of pages12
JournalCephalalgia
Volume33
Issue number16
DOIs
Publication statusPublished - Dec 2013

Fingerprint

Magnetic Resonance Imaging
Headache
Microvascular Decompression Surgery
Headache Disorders
Trigeminal Nerve
Brain
Phenotype
Drug Therapy
Injections
Therapeutics
gabapentin
lamotrigine
topiramate

Keywords

  • autonomic
  • microvascular decompression
  • neurovascular compression
  • SUNA
  • SUNCT

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

SUNCT/SUNA and neurovascular compression : New cases and critical literature review. / Favoni, Valentina; Grimaldi, Daniela; Pierangeli, Giulia; Cortelli, Pietro; Cevoli, Sabina.

In: Cephalalgia, Vol. 33, No. 16, 12.2013, p. 1337-1348.

Research output: Contribution to journalArticle

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abstract = "Background: Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) and short-lasting unilateral neuralgiform headache with cranial autonomic symptoms (SUNA) are primary headache syndromes. A growing body of literature has focused on brain magnetic resonance imaging (MRI) evidence of neurovascular compression in these syndromes. Objective: The objective of this article is to assess whether SUNCT is a subset of SUNA or whether the two are separate syndromes and clarify the role of neurovascular compression. Method: We describe three new SUNCT cases with MRI findings of neurovascular compression and critically review published SUNCT/SUNA cases. Results: We identified 222 published SUNCT/SUNA cases. Our three patients with neurovascular compression added to the 34 cases previously described (16.9{\%}). SUNCT and SUNA share the same clinical features and therapeutic options. At present, there is no available abortive treatment for attacks. Lamotrigine was effective in 64{\%} of patients; topiramate and gabapentin in about one-third of cases. Of the 34 cases with neurovascular compression, seven responded to drug therapies, 16 patients underwent microvascular decompression of the trigeminal nerve (MVD) with effectiveness in 75{\%}. Conclusions: We suggest that SUNCT and SUNA should be considered clinical phenotypes of the same syndrome. Brain MRI should always be performed with a dedicated view to exclude neurovascular compression. The high percentage of remission after MVD supports the pathogenetic role of neurovascular compression.",
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